Double Take: Take depression in teens seriously

Dear Dr. Wes and Katie: We used to hear a lot about depressed teenagers. Then there was the concern about too many kids being on antidepressants and that medication might even make things worse. What’s your current view of this? I can’t tell if my daughter is just moody like a normal kid or if there’s something more wrong. I don’t want to label her for no good reason.

Katie: Though treatments may change over time, depression in teenagers has always been and continues to be very real.

If you could spend a day as an invisible observer exploring my high school, you would encounter many teens passing the day in untreated misery, perhaps isolating themselves from peers or silently despairing behind a mask of contentment. Scratched out in restroom stalls you’d find sad notes of self-hatred and suicide so common that the handwriting often becomes recognizable from one stall to the next.

The problem, as you noted, is recognizing the symptoms of depression beyond the normal emotional twists and turns of adolescence. It’s only human to have the occasional “off” day, and for teenagers, those days of sulkiness and irritability usually occur more than occasionally.

Some teens experience more intense emotional growing pains than their peers. The moodiness you mentioned becomes concerning when it appears to permanently affix itself over a teen’s head, engulfing his or her true personality and happiness.

While situational depression may be a temporary stage in a teen’s life, it warrants the same close attention paid to chronic depression. If your daughter’s melancholy seems more like a steady Seattle downpour than a passing drizzle, it’s worth a trip to your primary care doctor to check up on her physical health and ask about local mental health professionals.

Talking regularly to a mental health professional is helpful with or without medication. Before making a decision about antidepressants, try a few therapy sessions. Medication doesn’t need to be the first resort.

However, keep in mind that although the possible side effects sound frightening, antidepressants do often help teens work through depression. I know a few teenagers personally who are open about their prescriptions. If you were to pass these kids in the hallway or sit with them at lunch, you would never guess the inner challenges they had overcome.

Dr. Wes: We’re halfway through Katie’s tenure on Double Take, and every week she makes it harder for me to match her work.

Whether you like “labels” or not, a good diagnosis is crucial. The first thing to consider is whether the symptoms result from normal problems of daily life or are instead present no matter what’s going on.

If there’s a recent divorce, romantic breakup, change in schools, problems in social relationships or academic failure, we presume a change in circumstances may bring relief. While these are common problems for teens, they aren’t easy and may in fact be quite traumatizing.

For many teens, depression is secondary to another mental health issue, typically ADHD or anxiety. For kids who have either, and especially for those with both, despair may follow closely behind.

The third flavor of depression can often be found by looking at family history. If parents or grandparents had chronic depression, diagnosed or not, their descendants may inherit those same genes.

It’s also important to note that while traditional adult symptoms are often present in teens, many express depression with irritability and even anger or aggression.

So, here’s the bottom line: Diagnosis from age zero to 20 isn’t easy, and depression is often misdiagnosed. While antidepressants quite literally save lives, they don’t help young people who don’t need them.

Assessing teens takes time and commitment, and, yes, a good therapist who can connect with your kid and figure out his or her nuances. If after a few sessions and some good dialogue, the therapist recommends a medication referral, don’t freak out. Well-used, I’ve seen meds help many kids in the short and long term.

Katie’s right. Depression remains a big issue, and a tough one. Thankfully, we’re moving past the point where depressed kids feel stigmatized and many candidly refer their friends when they see things getting out of hand. Don’t hesitate to send your daughter down that road to see what you find.

Comments

1) Depression in teenagers, as in anyone else, should never be taken lightly. And, the mistake should not be made that it is necessary to reach the teenage years before a person can have a problem with depression.

If you have a child that is suffering from depression, you can discover part of the problem by looking in the mirror. Be sure to spend time with your children, at least a few times a week. And for much more than just a couple minutes. That is much more important than bowling or whatever your other hobbies are. Bowling or whatever will still be there after your children are grown up and gone,,, or just gone.

Show an interest in their problems, and never, ever be shocked at what they tell you. Go and do things with them, things that interest them. You might have to feign an interest, but put up with it, this is only for a few years, and your children will remember it for their whole lives. They are likely to brag to their friends about how their parents went and did things with them, whatever they wanted to that was within the family budget.

And, it is during quality time with your children that you need to talk about things they enjoy doing, and things that bother them. If they can't seem to think of anything they enjoy doing, that's a danger sign, and the article above is a good one to read a second time.

But, it is true that many teenagers and other people hide depression very well. It will take patience, and maybe the assistance of the high school counselor or your family physician to determine if professional psychiatric assistance is likely to be helpful.

There may be a cost involved, and it might strain the family budget. If that problem comes up in an argument with your spouse, here's a good one to remember, to be delivered in a whisper in private ONLY: "Honey, a funeral costs $5,000."

Your teenager may talk to a therapist for a few sessions, and hopefully, the problem will be quickly resolved, maybe with a few sessions later.

2) But that might not be enough, antidepressants might be needed. But, they are not magic. With only a couple exceptions that are used in desperate situations, they will take a long time to work, that is, about six weeks to reach maximum effectiveness. There's another problem in that the first one tried may not be effective, for reasons that are not well understood, some work well for some people, and others work well for other people.

But when you're young and depressed, sex weeks sounds like forever. That is a time when your teenager will need a lot of help and support. And then, it might need to be done all over again. I'm pretty sure that you're going to have found an effective one before trying three or four, that will not go on forever. And, many of the antidepressants are generic, meaning they are the $6 per month scripts that you can get at many drugstores, so the cost won't exhaust the family budget in these trying times.

There is one serious problem that I didn't mention above. Not all teenagers have a supportive family to help them through what might be the most trying time of their life.

If you are a teenager, or anyone else, and desperate for someone to talk to about the above topics, or anything else that really bothers you, please call Headquarters at 841-2345. You can talk to someone for a while, and they can refer you to other people and agencies that can help you that are within your budget.